7 Signs It's Time to Review Your Medicare Coverage

Choosing a Medicare plan isn't a one-time decision. While many people enroll in a plan and let it automatically renew year after year, your healthcare needs, prescription medications, doctors, and even the plans themselves can change over time.

That doesn't necessarily mean you need a different Medicare plan every year. In fact, many beneficiaries find that their current coverage is still the right fit. But taking time to review your options and confirm that your plan continues to meet your needs is key to having the right coverage at the right price point.

So, whether you've recently experienced changes in your health or you have had the same coverage for several years, an annual Medicare review can help you avoid unexpected costs, maintain access to your preferred providers, and feel confident heading into the new year.

Here are seven signs it may be time to take a closer look at your Medicare coverage.

Choosing a Medicare Plan Isn't "Set It and Forget It"

A Medicare plan that worked well when you first enrolled may not be the best fit forever, and that's perfectly normal.

Your health can change. You may start seeing new specialists, begin taking different prescriptions, move to a new area, or simply find that your healthcare priorities have shifted. At the same time, Medicare Advantage and Part D prescription drug plans can update premiums, provider networks, covered medications, copays, and benefits from one year to the next.

Reviewing your coverage each year isn't about looking for reasons to switch plans. It's about making sure your current plan still aligns with your healthcare needs, budget, and lifestyle.

If any of the following situations sound familiar, now is a good time to schedule a Medicare plan review.

7 Signs You Should Review Your Medicare Coverage

1. Your Prescription Medications Have Changed

Prescription drug coverage is one of the most common reasons Medicare beneficiaries discover their current plan may no longer be the best fit.

Even adding one new medication can affect your out-of-pocket costs if it's covered differently under your plan's formulary or placed in a higher pricing tier. Likewise, a medication you've taken for years could move to a different tier, require prior authorization, or no longer be covered by your current prescription drug plan.

It's also worth checking whether your preferred pharmacy is still in your plan's network, as network changes can impact what you pay for the same prescription.

If your medications have changed since your last enrollment period, reviewing your Medicare coverage could help you avoid paying more than necessary.

2. You've Started Seeing Different Doctors or Specialists

Whether you've switched primary care physicians, been referred to a new specialist, or have moved in the past year, it's important to confirm that your providers will be in your plan's network.

You can check your network by calling the carrier, requesting a provider booklet, or searching the online database. Keep in mind that while these networks are usually finalized by about October 1, they are sometimes not officially locked in until January 1 of the following year.

Reviewing your plan now can help reduce the likelihood of unexpected out-of-network costs or the need to find new providers later.

3. Your Healthcare Needs Have Changed

Life doesn't always stay the same, and neither do your healthcare needs.

Maybe you've been diagnosed with a chronic condition, scheduled for surgery, started physical therapy, or just find yourself visiting the doctor more often than you used to. These changes can affect which Medicare plan offers the best overall value.

A plan that was ideal when you needed only routine preventive care may not provide the same level of value if your medical needs have increased.

An annual review helps ensure your coverage will continue to support both your current health and any anticipated care in the coming year.

Find Out: Do Medicare Plans Automatically Renew?

4. Your Healthcare Costs Keep Increasing

If it feels like more of your monthly budget is going towards healthcare costs each year, your Medicare plan deserves a closer look.

While many people focus on monthly plan premiums, it's just as important to consider deductibles, copays, coinsurance, prescription drug costs, and your plan's maximum out-of-pocket expenses. Sometimes a plan with a slightly higher monthly premium may actually result in lower overall healthcare costs depending on how often you use medical services and how it covers your prescriptions.

Reviewing your coverage with a professional gives you the chance to evaluate your total healthcare spending, not just the one number on your monthly bill. At Twin City Underwriters, we have helped seniors save hundreds, and sometimes even thousands, of dollars on healthcare costs by switching plans.

5. You've Moved or Spend Part of the Year in Another State

Where you live and where you receive medical care impacts which Medicare plans are available to you.

If you've recently moved, plan to relocate to be closer to family, or split your time between two states (such as spending the summers at your cabin or the winters in the south), your current Medicare Advantage plan may no longer offer the same provider access or coverage in your new or secondary location.

Even if you haven't moved permanently, it's worth reviewing your options if you regularly spend several months away from home each year. Making sure your coverage works where you live and receive care can help prevent unnecessary surprises when you need medical services.

How to Prepare for the Medicare Annual Enrollment Period (AEP)

6. You Haven't Reviewed Your Medicare Plan in Several Years

One of the biggest signs it's time for a Medicare review is simply that it's been a while.

Many beneficiaries automatically renew their coverage year after year, and that's easy to do. But over time, plans do change, even if it's little by little each year. Provider networks change, prescription drug formularies are updated, benefits are added or removed, and new Medicare plans become available.

Even if you're mostly satisfied with your coverage, reviewing your plan every year helps confirm that it's still meeting your healthcare needs and financial goals. Keep in mind that a review like this can be done at any time during the year. While you can generally only make changes to your coverage during specific enrollment periods, doing a midyear check-in can remind you of what to watch for when the next enrollment window begins.

And, sometimes the best outcome is finding out that your current plan is still the right choice. Other times, a review uncovers opportunities to improve coverage or lower costs you may not have been aware of.

What is an ANOC and What Do I Need to Know About It?

7. Annual Enrollment Period Is Approaching

The Annual Enrollment Period (AEP) runs annually from October 15th to December 7th and is one of the best times each year to review your Medicare coverage.

Rather than waiting until the last minute, we recommend starting your review as soon as information about next year's plans becomes available. Every Medicare beneficiary has access to Medicare.gov which lists all the plans available to you. A paper version is given to you by the Medicare & You booklet that comes in the mail. And Twin City Underwriters has the following year's plan information available as soon as October 1st. To make the process of understanding changes in coverage as simple as possible, Twin City Underwriters offers, to their current clients only, Annual Notice of Changes (ANOC) meetings as well as personalized annual review appointments.

Taking the time to compare your options before the December 7th enrollment deadline gives you the opportunity to make thoughtful decisions instead of rushed ones. 

During AEP, eligible Medicare beneficiaries are able to:

• Change from one Medicare Advantage plan to another.
• Join, switch, or drop a Medicare Part D prescription drug plan.
• Move from Original Medicare and a Medicare Advantage plan.
• Move back to Original Medicare with a Medigap plan, if eligible.

Even if you don't end up making any changes, reviewing your plan during AEP can provide the reassurance that your doctors, prescriptions, healthcare needs, and budget are still well supported for the coming year.

Don't Wait for AEP to Start Thinking About Your Coverage

Before the review period even begins, try to answer these questions:

✓ Have any of my prescriptions changed?

✓ Am I seeing different doctors or specialists?

✓ Did I not receive an Annual Notice of Change booklet?

✓ Have my healthcare costs increased?

If you answered "yes" to any of these questions, it could be time to schedule a Medicare plan review.

The Best Medicare Review Isn't About Finding a "Better" Plan

A lot of people think an annual review means changing plans every year.

But that's not the goal.

"One of the biggest misconceptions we hear is that every Medicare review ends with changing plans. In reality, some of the best appointments end with us telling someone they're already in a great plan and keep everything the same for the upcoming year. Our job isn't to move you to a new plan, it's to make sure your coverage still matches your lifestyle, healthcare needs and budget." - Twin City Underwriters Agent

Oftentimes the value of an annual Medicare review comes from knowing:

• nothing significant changed
• your doctors remain covered
• your medications are still affordable
• you aren't missing new plan options available

Although there are times when making a change makes sense, an experienced Medicare agent often recommends keeping the exact same coverage, because it still meets your needs.

How to Know What Type of Medicare Review You Need

When you receive your ANOC paperwork from your carrier in September, the best first step is to join one of our group sessions. These events walk you through the upcoming updates to your coverage so you know exactly what to watch for. Not every agency offers these educational events, but at Twin City Underwriters, we provide them as a benefit to our clients. You are invited by email and mailed a newsletter informing you of the dates and times and locations available for the various insurance carriers. You can also call the office to RSVP. For many people, attending an ANOC provides all the clarity they need without having to schedule an individual appointment.

If you have reviewed your plan materials or attended an ANOC event and just have a few specific questions, a quick phone call is often all you need. We know 30 minutes might seem short, but with our focused questions, it is plenty of time. We always welcome follow-up calls if needed.

• Your plan's benefits are changing significantly or the plan is going away entirely. If your plan falls into this category, please watch for a postcard and/or email from us.
• Your preferred clinic system or doctor is no longer in your plan's network. You may receive a letter from your provider stating this.
• You have had changes to your medication list that are resulting in high out-of-pocket costs.

Frequently Asked Questions on Reviewing Medicare Coverage

How often should I review my Medicare plan?

You should review your plan materials at least once a year, especially before the Annual Enrollment Period (AEP), even if you're happy with your current coverage. Once you know the key changes to look for in your plan’s updates, you may not need to meet with an agent every year. However, if anytime during the year your health needs change, or you have questions about your coverage, a Twin City Underwriters agent is ready to help.

Can my Medicare plan change?

Yes, depending on the type of plan you have. If you are enrolled in a Medicare Advantage plan or PDP, your premium, provider networks, prescription drug formularies, copays, and covered benefits can all change from year to year. However, if you have a Medigap (Medicare Supplement) plan, your standardized coverage benefits do not change from year to year, though your monthly premium may.

What is the Annual Enrollment Period?

The Annual Enrollment Period (AEP) runs each Fall from October 15th - December 7th and allows eligible Medicare beneficiaries to review and make certain changes to their Medicare coverage for the following year.

Do I need to change my Medicare plan every year?

No. Many people keep the same plan. The main goal is to verify if your coverage still meets your healthcare and financial needs.

Should I talk with a Medicare insurance agent every year?

Working with a licensed Twin City Underwriters Medicare insurance agent each year can help you understand plan changes, compare available options, and determine whether your current coverage still fits your needs. However, attending an ANOC event or visiting with an agent at another time in the year can also work very well to ensure your coverage still fits your needs.

Does Twin City Underwriters offer appointments for Medicare reviews?

Yes, Twin City Underwriters offers free, no-obligation annual Medicare reviews and year-round support. We offer in-person, phone, and video appointments to fit your schedule. Our team of licensed agents serve Medicare beneficiaries in Minnesota, Wisconsin, North Dakota, South Dakota, Iowa, and Florida.

Click here to schedule your free Medicare review today

What happens if I don't do anything?

In most cases, if you do not take any action, you will stay enrolled in the same Medicare plan for the following year. Be sure to check any documents you receive from your insurance carrier to be aware of any potential changes in costs and coverage.

Schedule Your Annual Medicare Review With Twin City Underwriters

Whether you've had the same Medicare plan for one year or ten, an annual review can help ensure your coverage still fits your doctors, prescriptions, healthcare needs, and budget. Before the Annual Enrollment Period arrives, talk with one of our licensed Medicare insurance agents to review your options and make informed decisions for the year ahead.

Sources:

https://www.medicare.gov/publications/11220-your-yearly-medicare-review.pdf

https://www.cms.gov/priorities/key-initiatives/medicare-open-enrollment-partner-resources

Choosing a Medicare plan can be difficult. Twin City Underwriters helps Medicare recipients in Minnesota, Wisconsin, North Dakota, South Dakota, Iowa and Florida find the Medicare plan that meets their unique needs. Schedule a one-on-one meeting with one of our Medicare insurance brokers to get your questions answered!

Do you need help with Medicare, insurance and health plans? Explore your options with Allina Health Aetna, BlueCross BlueShield of Minnesota, Medica, HealthPartners, Health Spring, Humana, Security Health Plan, United HealthCare and more. We work with you to find the best plan for your needs and budget. Contact us today to get started.